Provider Demographics
NPI:1821548579
Name:DONATH, IVY
Entity type:Individual
Prefix:
First Name:IVY
Middle Name:
Last Name:DONATH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6511
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61601-6511
Mailing Address - Country:US
Mailing Address - Phone:309-531-6684
Mailing Address - Fax:
Practice Address - Street 1:1221 KENTUCKY ST
Practice Address - Street 2:
Practice Address - City:DEER LODGE
Practice Address - State:MT
Practice Address - Zip Code:59722-2045
Practice Address - Country:US
Practice Address - Phone:406-850-0182
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-06
Last Update Date:2024-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Single Specialty
No1744R1102XOther Service ProvidersSpecialistResearch StudyGroup - Single Specialty
No347C00000XTransportation ServicesPrivate Vehicle
No374U00000XNursing Service Related ProvidersHome Health Aide
No376K00000XNursing Service Related ProvidersNurse's Aide
No172A00000XOther Service ProvidersDriver
No1744G0900XOther Service ProvidersSpecialistGraphics DesignerGroup - Single Specialty